Tranexamic Acid in Reducing the Need for Blood Transfusion: A Prospective Randomized Controlled Trial.

Abstract

Open abdominal myomectomy is associated with a significant risk of hemorrhage and blood transfusion. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in Gynecological other surgical disciplines to reduce blood loss during surgery. However, its efficacy in reducing blood transfusion requirements when used as an adjunct to pericervical tourniquet has not been well elucidated. In a placebo-controlled trial, we assessed the effect of intravenous tranexamic acid as an adjunct hemostat with pericervical tourniquet on blood loss and transfusion requirements following open abdominal myomectomy in 132 women, aged 18–65 years. The patients were randomly allocated to receive either intravenous Tranexamic acid 1gm or placebo pre-operatively.  The volume of intraoperative blood loss, blood transfusion rate and total number of units transfused and the complications associated with the use of tranexamic acid were evaluated during the first 72 hours following surgery. One hundred and thirty one (131) patients completed the study. Patients who received tranexamic acid recorded a significantly reduced blood loss 415.4 ± 173.2ml compared to the placebo group 807.5 ± 366.6ml ( p < 0.001 ). Blood transfusion was significantly higher in the placebo group 47(72.3% ) than tranexamic acid group 6 ( 9.1% ) ( p < 0.001 ) with a statistically significant decrease in the mean postoperative hemoglobin in the placebo group 8.7 ± 1.9g/dl (median = 8.4, range = 4 - 12) compared to the tranexamic acid group 9.3 ± 1.1g/dl ( median = 9.8, range = 7 - 11.5).

 There was no difference in occurrence of complications between the groups.

CONCLUSION. In patients who underwent open abdominal myomectomy tranexamic acid as an adjunct hemostat to pericervical tourniquet reduced blood loss and blood transfusion requirements with comparable side effect compared to placebo.

Key words: Uterine fibroid, Myomectomy, Blood transfusion, Blood loss, Tranexamic acid, Peri-cervical Tourniquet

Sources of Funding: None

Conflict of Interest: None